An Episcopal (Anglican) Chaplain in the Saint Luke's Health System of Kansas City, reflecting on work and faith and life. NOTA BENE: my opinions are my own and do not represent the Episcopal Church or the Saint Luke's Health System.

Thursday, June 30, 2016

Any regular readers know that I'm always attentive to any new chaplain voices that pop up in the blogosphere. In this case, it's not that this person has just popped up. However, she's just come to my attention. She's actually been blogging longer than I have.

The name of the blog is Diary of a Contemplative. The Blogger is Amy Kumm-Hanson, an ELCA Chaplain. As I notes, she's been out here longer than I have (although not nearly so long as a chaplain). So, for those of us in the business - or just interested in the business - give her work a look.

One point to appreciate about the report is an entire section on “Limitation of Scope” (pp. 11 forward). The authors are discrete in describing what they are doing, and a clear sense of what they can and can’t do. For good reasons (again, it’s worth reading, so you can look at these yourselves) they note that they are looking at the North American environment for chaplains, and at acute care settings. They note specifically that “A review of the extensive literature on the influence of spirituality and religion on health is beyond the scope of this report.” (p. 12)

It seems to me that this highlights a theme in the report: to emphasize the research on chaplaincy specifically, and especially that done by and/or for chaplains. It is an arguable approach. I can see the point, but it also misses a point. One of my concerns has been that we don’t read other professions’ research.

This is a comment I have made before, but I think it worth making again, and especially in considering this report on research that can guide and benefit chaplaincy. Research that speaks to spirituality, and so to the area of expertise of chaplains, appears in journals of a variety of professions. A review of the bibliography that the report includes demonstrates that to some extent. However, as the report focuses on chaplaincy specifically it doesn’t give a clear idea of the breadth of research to consider, whether in medical, nursing, psychology, or social work journals.

Now, I have noted that some of that research isn’t all that helpful (although I believe profoundly we need to be responding to it for that reason.) On the other hand, some of it is. We need to be reading it to see what our professional colleagues might be seeing, and to see what might be useful for us.

We need also to attend to the research on the correlation between religious behavior and health. The authors of this report allude to that work. They also note that there is criticism of that work. It often is hard to address the mechanism: that is, to identify the causative factor that brings the correlation about. While this is legitimate, I believe it overlooks the perspective of the individual patient that the motivation or association or affiliation that contributes to the result is religious. While not specifically about chaplaincy (and not always necessarily helpful for chaplaincy) it is research we need to be conversant about.

I would also note that there is a good deal of research now to describe the current religious and spiritual landscape in the United States (and perhaps more broadly in North America). Most of this has been done for faith communities, most of them Christian, who want it to help focus evangelism. Evangelism is specifically not an interest of chaplains. However, the religious and spiritual landscape is very important for us. That includes both some sense of how people are affiliated, and also some sense of the spiritual lives of those who are not affiliated. One of my touchpoints with my own administrators is that with the growing number of folks who are indeed spiritual (expressed in familiar terms) but not religious (in the sense of being part of an institution) there is greater need for chaplains. We are those best prepared to support those with spiritual needs and no outside professionals to call on.

The authors are correct that chaplains need to be doing research to better describe and guide our work. We also need to be reading other professions’ research, whether it seems applicable initially or not. A report comparable to this that gave some review of where else we might be reading, and what we might want to recognize, appropriate, or challenge in the research of other groups would also be a valuable contribution.

Sunday, June 19, 2016

The Healthcare Chaplaincy Network (HCCN) has disturbed the chaplaincy profession with the decision to establish the Spiritual Care Association (SCA). While I don't think it was necessary, my position is basically that of Gamaliel in the Acts of the Apostles. I plan not to say too much about it, and trust in God. If it brings benefits it will stand. If it doesn't, it will fail without help from anyone else.

With all the criticism, though, of HCCN for starting a new organization, I think there is some point in appreciating other things that they have contributed. They have provided support for a number of projects. They have been especially interested in research. HCCN leadership has felt that, to the extent possible, the profession should be evidence-based, and research is how we get the evidence.

Not that I'm going to do that here - at least, not in full. The document is 88 pages, with a great deal of information to digest. So, I'm not going to do single review of the entire piece. I am, however, going to look at some interesting parts of it.

I am going to recommend that we all read the first section of the paper, the Executive Summary. There is plenty of information there to consider. There is a summary review of chaplaincy in healthcare, and an argument that chaplaincy should be research-based.

Also helpful, and especially helpful to include in the Executive Summary is Gap Analysis, a list of areas for research that would benefit the profession. The list itself is both exciting and appalling: it is both excitingly thorough and depressingly long. We have a lot of work to think about doing.

I happen to agree that our profession can and should do research. However, my concern is that we're not doing research that could benefit us. As the Executive Summary states,

Since chaplaincy research has only begun to accumulate, there is a significant danger that research will not proceed in a focused and organized manner.

We're not alone in that. In this recent story on NPR it was observed that in many fields that's an issue. There is excitement over the new and groundbreaking, but not much over confirming (or disproving) something already started.

For chaplains, at least, this has resulted in a host of small studies, essentially pilot studies that demonstrate (if they demonstrate anything) that a subject can be studied, and that perhaps there is value in studying it again. And if no one actually studies it again, the potential value is lost. So, the authors point out,

If study questions, methods and outcomes are carefully chosen they will build upon and integrate with other work in the field of spiritual care. One way to support a focused research agenda is to fund research through one or more central consortia, which would set the research agenda, fund studies through a Request for Proposals process, and promote communication and capacity building among the research groups. The consortium would be advised by clinical and research leaders in chaplaincy who would set the basic parameters of the research, monitor its progress, and serve as mentors to new researchers.

This is certainly an issue that the professional organizations, and larger chaplaincy institutions (like HCCN) might take up, whether individually or as part of a proposed consortium: choosing topics for study, or replicating worthwhile pilot studies, on a large, even multicenter scale. We might even be able to leverage recent changes in healthcare in general to support that. For example, a number of centers using the same electronic medical record platform might add specific pieces to their documentation. That would allow consistency and ease of access to the data across a variety of institutions. Such a proposed consortium, or even a single body adept at coordination and grant writing, could help make these meaningful steps.

The paper, Literature Review - Testing the Efficacy of Chaplaincy Care, from HCCN is a significant contribution to the field, one that many may have missed. I think all of us should review at least the Executive Summary. Those of us with a more active interest in research should dig further (and, after all, for those of us whose continuing education requirements include some focus on research, there are several contact hours to be acquired here, covering the good work). While HCCN has become a center of controversy, we also do not want to ignore their important contributions, including this one.